Radiologists, Medical Radiation, and the Public Health

During the early years of his practice Dr. Frederick O'Brien, whom we honor today, was less concerned with genetic and somatic effects of radiation. As his many papers on radiation therapy indicate, he was, rather, involved with the technics of delivery of adequate radiation doses to cancer tissue. He would be greatly stimulated today were he able to utilize the great scientific advances in therapy made available by the spectacular progress of nuclear physics, radiobiology, and computers. At the same time, with the keen perception so apparent in his writings he would be quite involved in those aspects of radiology which impinge on the public health. Radiology here is used in the broadest sense to include any forms of ionizing radiation which in any form can benefit or harm our ecosystem. Public health refers to human beings in large groups or a population rather than individuals only. As far back as the mid 1950s, concern began to be voiced about possible deleterious effects of medical radiation. In 1957 bills were introduced in Congress for a National Radiation Health Institute and an Office of Radiation Health Control in the Public Health Service (1). More than a decade later these issues remain very much alive, even though many advances in our understanding have been achieved. The purpose of this communication is to examine the present relations of radiology to the public health so that our chosen field may continue its rapid and important growth in the most efficient way with further increases in benefits to human beings. Medicine today is faced with great questions in regard to the distribution and cost of medical services. The cost of medical services rises at about 8 per cent per year with about 3.7 per cent representing medical care costs (2). In radiology our costs rise because of more complicated technology, increased services, and the need for increased protection. It is necessary to achieve an appropriate balance between the cost of protection and the cost of patient services, remembering that research and training also require support. Should funds be spent for beam collimators and shields, for personal radiation diaries and increased records, for both or none? One may suspect that the practicing radiologist is a bit vague concerning his relation to the public. As shown in Figure 1, he has a dual relationship. The first is in the familiar doctor-patient relationship where he is aided by the radiological physicist and the technician. His second relationship is far less obvious. Here he is responsible for the delivery of certain amounts of radiation to a large population. At present, diagnostic radiologic services are growing at an annual rate of about 7 per cent, radiation therapy at about 2 per cent, and nuclear medicine at 15 per cent. As long as the increase is on the side of benefit it is justified.